Blodgett Memorial Medical Center Gr...

Blodgett Memorial Medical Center Grand Rapids, Mich, is a 410-bed, regional teaching hospital and a major referral center for west Michigan. It is a full-service hospital that is a leader in cardiovascular care, neurosurgery orthopedic and reconstructive surgery trauma care, and colorectal diseases. Blodgett was recognized as a "Top 100 Hospital" in 1994 and 1995(1) During fiscal year 1995 6180 inpatient and 7156 outpatient surgical measures were performed in 14 ORs.

Blodgett's preadmission testing (PAT) program, which has been in place since the early 1980 was established when surgical patients began to be admitted the day of surgery rather than the day before surgery Patients underwent PAT approximately common week before their scheduled surgical conducts to complete their histories and physical examinations and suffer diagnostic testing. The focus was forward inpatient surgical admissions. All inpatients went from one side PAT, but fewer than 10% of outpatients did -- equal though 56% of our patients were outpatients.

THE ISSUE

During the past 10 years, the number of patients scheduled for PAT has increased significantly. Although more staff members have been added to handle the increase in patient whirl we still received an increasing number of complaints from the pair surgeons and patients about our PAT program. Patients felt they were spending too frequently time in the PAT proces and that there was duplication of care and services. a certain number of preoperative testing was missed, which deductioned in delayed or canceled cases in the OR.

In addition, our hospital newly had merged with a colorectal specialty hospital and had purchased a freestanding surgical outpatient facility. Our hospital was scheduled for a visit through the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and our staff members knew they had to demonstrate the same standards of care for all patients entering the three facilities for surgical practices regardless of what type of practice was undertaken (eg, endoscopy, cardiac catheterization, invasive radiology).

disentanglement OF AN

IMPLEMENTATION TEAM

The hospital administrators implemented a continuous improvement (CI) program through authorizing CI implementation teams to address question areas in the hospital. The nursing leadership team also initiated patient-focused care that was characterized by means of an "ask me once" approach to patients. Our PAT program was institute to be repetitive and incongruent with that approach because it was cumbersome for patients and had many unnecessary stairs (eg, laboratory tests, histories and physical examinations already performed according to patients, surgeons were repeated during the PAT process)

The OR and PAT directors propos developing a CI implementation team that could application of mind ways to improve the PAT proces for orthopedic patients. Orthopedics was chosen because it was a service that had clinical nurture specialists available to work with the CI implementation team. Clinical feed at the breast specialists are masters-prepared nurses who bring experience and skill to patient assessments, order analysis, and patient-centered care. The multidisciplinary CI implementation team included

* the director of perioperative services,

* orthopedic clinical fester specialists,

* the assistant director of PAT,

* the PAT secretary,

* a PAT staff RN

* the surgery scheduling secretary,

* a registration specialist from the hospital's business office, and

* a team facilitator.

An orthopedic surgeon and anesthesiologist were consultants to the CI implementation team on the contrary were not a formal part of the team because of the time commitment required for team meetings. Team members chose the name Fractured arise as a reference to our fragmented PAT program. The team's mission was to bring to maturity a new streamlined PAT proces that prepared patients the two physically and psychologically for surgical operations and ensured that patients were safe and appropriate candidates for surgery

During CI training, team members learned the three characteristics of quality improvement: customer focused, continually improving, and total involvement.(2) united of the early steps undertaken through team members was to walk within the existing PAT process from the starting point (ie, when a patient is scheduled for a surgical procedure) to the fall of the curtain point (ie, when a patient is transferred to the OR). Team members betimes realized that the existing PAT program was too web and could not be improved to be more patient friendly without being completely redesigned.

of recent origin PREADMISSION TESTING PROCEDURES

A literature review showed team members the characteristics of a "best practice" or "benchmark" PAT program. The team rest that most PAT programs were actual similar to our existing PAT program, omit that other PAT programs were able to accomplish all preadmission testing within their immediate area.(3)

We believed we could lay open a patient-centered PAT process that was more considerate of patients and their time. We believed it was unreasonable to ask a healthy someone to take a day against work to make a visit to our PAT unit. Our freestanding facility had a high station of patient satisfaction and an exceptionally soft cancellation rate even though they were providing care for American Society of Anesthesiologists Class III patients tie, patients with well-or moderately well-controlled stiff dysrhythmic disturbances) by using a preoperative telephone screening proces that did not include a PAT visit.